Provider Demographics
NPI:1649786526
Name:DU FRESNE, JACQUELINE DUNCAN (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:DUNCAN
Last Name:DU FRESNE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4791 BUNCHBERRY LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-1372
Mailing Address - Country:US
Mailing Address - Phone:719-231-2389
Mailing Address - Fax:
Practice Address - Street 1:4617 AUSTIN BLUFFS PKWY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-2937
Practice Address - Country:US
Practice Address - Phone:719-231-2389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9315225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist